CPT code 98972: Digital assessment, 21 or more minutes2026 Medicare rate & RVUs in Puerto Rico
Reports an established patient's online digital assessment and management by a qualified nonphysician health care professional when cumulative service time reaches 21 minutes.
In Puerto Rico, Medicare pays $34.50 for 98972 in the office and $29.10 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 98972 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 98972 covers
A qualified nonphysician health care professional uses an asynchronous online exchange, such as a secure patient portal, to assess and manage an established patient's health concern. The work may include reviewing the patient's submitted information, evaluating the concern, and sending clinical guidance or a management plan. The code captures cumulative service time across a period of up to seven days, rather than a single face-to-face visit or telephone call.
Report 98972 when documented time for the online assessment and management reaches 21 minutes or more during that service period. The record should support the patient's concern, the online exchange, the clinical work performed, and the total time counted. CMS assigns 0.69 work RVU, 0.31 office practice-expense RVU or 0.15 facility practice-expense RVU, and 0.03 malpractice RVU.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Puerto Rico compares for 98972
Across 109 of 109 payment localities, the office rate for 98972 runs from $32.46 in Arkansas to $46.15 in Alaska. Puerto Rico pays $34.50. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$34.50
- Los Angeles, CA · California$36.91+$2.41
- Washington, DC area · District of Columbia$37.60+$3.10
- Miami, FL · Florida$36.36+$1.86
- Chicago, IL · Illinois$35.91+$1.41
- Manhattan, NY · New York$38.14+$3.64
- Alaska · Alaska$46.15+$11.65
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $32.67 | $28.00 |
| ArkansasArkansas | $32.46 | $27.87 |
| ArizonaArizona | $33.94 | $28.76 |
| Bakersfield, CACalifornia | $35.44 | $29.59 |
| Chico, CACalifornia | $35.32 | $29.47 |
| El Centro, CACalifornia | $35.33 | $29.47 |
| Fresno, CACalifornia | $35.32 | $29.47 |
| Hanford, CACalifornia | $35.32 | $29.47 |
| Madera, CACalifornia | $35.32 | $29.47 |
| Merced, CACalifornia | $35.32 | $29.47 |
| Modesto, CACalifornia | $35.32 | $29.47 |
| Napa, CACalifornia | $38.65 | $31.61 |
| Oxnard, CACalifornia | $36.55 | $30.24 |
| Redding, CACalifornia | $35.32 | $29.47 |
| Rest of CaliforniaCalifornia | $35.32 | $29.47 |
| Riverside, CACalifornia | $35.66 | $29.81 |
| Sacramento, CACalifornia | $36.46 | $30.24 |
| Salinas, CACalifornia | $36.30 | $30.10 |
| San Diego, CACalifornia | $36.66 | $30.27 |
| Marin County, CACalifornia | $40.30 | $32.76 |
| San Francisco, CACalifornia | $40.26 | $32.73 |
| San Benito County, CACalifornia | $41.05 | $33.34 |
| Santa Clara County, CACalifornia | $40.91 | $33.20 |
| San Luis Obispo, CACalifornia | $35.77 | $29.68 |
| Santa Cruz, CACalifornia | $36.65 | $30.16 |
| Santa Maria, CACalifornia | $36.30 | $30.07 |
| Santa Rosa, CACalifornia | $36.99 | $30.43 |
| Stockton, CACalifornia | $35.32 | $29.47 |
| Vallejo, CACalifornia | $38.61 | $31.56 |
| Visalia, CACalifornia | $35.32 | $29.47 |
| Yuba City, CACalifornia | $35.32 | $29.47 |
| ColoradoColorado | $35.12 | $29.44 |
| ConnecticutConnecticut | $35.87 | $30.12 |
| DelawareDelaware | $34.29 | $29.01 |
| Fort Lauderdale, FLFlorida | $35.35 | $29.93 |
| Rest of FloridaFlorida | $34.45 | $29.34 |
| Atlanta, GAGeorgia | $34.84 | $29.41 |
| Rest of GeorgiaGeorgia | $33.48 | $28.71 |
| Hawaii, Guam, HIHawaii | $35.40 | $29.32 |
| IowaIowa | $32.92 | $28.03 |
| IdahoIdaho | $33.05 | $28.13 |
| East St. Louis, ILIllinois | $34.59 | $29.67 |
| Rest of IllinoisIllinois | $34.07 | $29.19 |
| Suburban Chicago, ILIllinois | $35.62 | $30.13 |
| IndianaIndiana | $33.13 | $28.18 |
| KansasKansas | $32.91 | $28.08 |
| KentuckyKentucky | $33.17 | $28.42 |
| New Orleans, LALouisiana | $33.93 | $28.90 |
| Rest of LouisianaLouisiana | $33.17 | $28.44 |
| Metropolitan Boston, MAMassachusetts | $37.25 | $30.87 |
| Rest of MassachusettsMassachusetts | $35.12 | $29.49 |
| Baltimore area, MDMaryland | $35.77 | $30.03 |
| Rest of MarylandMaryland | $34.68 | $29.27 |
| Rest of MaineMaine | $33.20 | $28.28 |
| Southern Maine, MEMaine | $33.94 | $28.64 |
| Detroit, MIMichigan | $34.73 | $29.57 |
| Rest of MichiganMichigan | $33.63 | $28.75 |
| MinnesotaMinnesota | $34.00 | $28.50 |
| Metropolitan Kansas City, MOMissouri | $33.75 | $28.73 |
| Metropolitan St. Louis, MOMissouri | $33.91 | $28.82 |
| Rest of MissouriMissouri | $32.95 | $28.34 |
| MississippiMississippi | $32.70 | $28.10 |
| MontanaMontana | $34.40 | $29.06 |
| North CarolinaNorth Carolina | $33.35 | $28.36 |
| North DakotaNorth Dakota | $33.81 | $28.46 |
| NebraskaNebraska | $32.98 | $28.05 |
| New HampshireNew Hampshire | $34.70 | $29.14 |
| Northern New JerseyNew Jersey | $37.58 | $31.38 |
| Rest of New JerseyNew Jersey | $36.37 | $30.54 |
| New MexicoNew Mexico | $33.74 | $28.84 |
| NevadaNevada | $34.25 | $28.90 |
| NYC suburbs and Long Island, NYNew York | $38.69 | $32.34 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $36.63 | $30.78 |
| Queens, NYNew York | $38.21 | $31.89 |
| Rest of New YorkNew York | $33.59 | $28.51 |
| OhioOhio | $33.51 | $28.63 |
| OklahomaOklahoma | $33.07 | $28.30 |
| Portland, OROregon | $35.66 | $29.73 |
| Rest of OregonOregon | $34.06 | $28.74 |
| Metropolitan Philadelphia, PAPennsylvania | $35.44 | $29.87 |
| Rest of PennsylvaniaPennsylvania | $33.50 | $28.59 |
| Rhode IslandRhode Island | $35.07 | $29.55 |
| South CarolinaSouth Carolina | $33.47 | $28.53 |
| South DakotaSouth Dakota | $33.74 | $28.39 |
| TennesseeTennessee | $33.00 | $28.14 |
| Austin, TXTexas | $34.94 | $29.28 |
| Beaumont, TXTexas | $33.40 | $28.54 |
| Brazoria, TXTexas | $34.27 | $28.98 |
| Dallas, TXTexas | $34.43 | $29.10 |
| Fort Worth, TXTexas | $34.34 | $29.07 |
| Galveston, TXTexas | $34.34 | $29.04 |
| Houston, TXTexas | $34.89 | $29.58 |
| Rest of TexasTexas | $33.78 | $28.71 |
| UtahUtah | $33.68 | $28.66 |
| VirginiaVirginia | $33.93 | $28.68 |
| Virgin Islands, VIUnited States Virgin Islands | $34.50 | $29.10 |
| VermontVermont | $33.80 | $28.51 |
| Rest of WashingtonWashington | $35.01 | $29.38 |
| King County, WAWashington | $37.72 | $31.17 |
| WisconsinWisconsin | $33.27 | $28.15 |
| West VirginiaWest Virginia | $33.48 | $28.83 |
| WyomingWyoming | $34.14 | $28.80 |
98972 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$32.46
$46.15
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $46.15 | 1 |
| AL | $32.67 | 1 |
| AR | $32.46 | 1 |
| AZ | $33.94 | 1 |
| CA | $35.32–$41.05 | 29 |
| CO | $35.12 | 1 |
| CT | $35.87 | 1 |
| DC | $37.60 | 1 |
| DE | $34.29 | 1 |
| FL | $34.45–$36.36 | 3 |
| GA | $33.48–$34.84 | 2 |
| GU | $35.40 | 1 |
| HI | $35.40 | 1 |
| IA | $32.92 | 1 |
| ID | $33.05 | 1 |
| IL | $34.07–$35.91 | 4 |
| IN | $33.13 | 1 |
| KS | $32.91 | 1 |
| KY | $33.17 | 1 |
| LA | $33.17–$33.93 | 2 |
| MA | $35.12–$37.25 | 2 |
| MD | $34.68–$37.60 | 3 |
| ME | $33.20–$33.94 | 2 |
| MI | $33.63–$34.73 | 2 |
| MN | $34.00 | 1 |
| MO | $32.95–$33.91 | 3 |
| MS | $32.70 | 1 |
| MT | $34.40 | 1 |
| NC | $33.35 | 1 |
| ND | $33.81 | 1 |
| NE | $32.98 | 1 |
| NH | $34.70 | 1 |
| NJ | $36.37–$37.58 | 2 |
| NM | $33.74 | 1 |
| NV | $34.25 | 1 |
| NY | $33.59–$38.69 | 5 |
| OH | $33.51 | 1 |
| OK | $33.07 | 1 |
| OR | $34.06–$35.66 | 2 |
| PA | $33.50–$35.44 | 2 |
| PR | $34.50 | 1 |
| RI | $35.07 | 1 |
| SC | $33.47 | 1 |
| SD | $33.74 | 1 |
| TN | $33.00 | 1 |
| TX | $33.40–$34.94 | 8 |
| UT | $33.68 | 1 |
| VA | $33.93–$37.60 | 2 |
| VI | $34.50 | 1 |
| VT | $33.80 | 1 |
| WA | $35.01–$37.72 | 2 |
| WI | $33.27 | 1 |
| WV | $33.48 | 1 |
| WY | $34.14 | 1 |
How the 98972 rate is calculated
Each of 98972’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 98972
RVUs × geographic indexes × conversion factor
Work0.69
0.69 RVUs× 1.000 GPCI
Practice expense0.31
0.31 RVUs× 1.000 GPCI
Malpractice0.03
0.03 RVUs× 1.000 GPCI
Adjusted RVUs
1.0300
Conversion factor
$33.4009
Medicare rate
$34.40
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,954
- Code
- 98972
- Physician work
- 0.69
- Practice expense
- 0.31
- Malpractice
- 0.03
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.69 | × 1.000 | 0.6900 |
| Practice expense | 0.31 | × 1.011 | 0.3134 |
| Malpractice | 0.03 | × 0.985 | 0.0295 |
| Total RVUs | 1.0330 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$34.50
Office: (0.69 × 1 + 0.31 × 1.011 + 0.03 × 0.985) × $33.4009 = $34.50
Facility: (0.69 × 1 + 0.15 × 1.011 + 0.03 × 0.985) × $33.4009 = $29.10
Payment rules and modifiers for 98972
98972 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 98972
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$34.40
- Non-facility (office)
- $34.40
- Facility
- $29.06
Higher because the practice carries its own overhead.
How 98972 has changed in Puerto Rico
98972 · Office / nonfacility
$34.50
Effective 2026-10-01
The base rate is $2.11 higher than on 2025-10-01, moving from $32.39 to $34.50 (6.5%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$32.39changed to$34.50
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 0.28 changed to 0.31
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$30.66changed to$32.39
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 0.21 changed to 0.28
- Malpractice RVU 0.02 changed to 0.03
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$30.16changed to$30.66
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$31.22changed to$30.16
- Conversion factor 33.8872 changed to 32.7442
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$31.18changed to$31.22
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$32.22changed to$31.18
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.20 changed to 0.21
- Malpractice RVU 0.04 changed to 0.02
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$32.84changed to$32.22
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 0.21 changed to 0.20
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
No ratechanged to$32.84
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
No ratechanged toNo rate
Held through RVU20B, RVU20C, RVU20D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $34.50 | $29.10 | RVU26D |
| 2026-07-01 | $34.50 | $29.10 | RVU26C |
| 2026-04-01 | $34.50 | $29.10 | RVU26B |
| 2026-01-01 | $34.50 | $29.10 | RVU26A |
| 2025-10-01 | $32.39 | $32.07 | RVU25D |
| 2025-07-01 | $32.39 | $32.07 | RVU25C |
| 2025-04-01 | $32.39 | $32.07 | RVU25B |
| 2025-01-01 | $32.39 | $32.07 | RVU25A |
| 2024-10-01 | $30.66 | $30.33 | RVU24D |
| 2024-07-01 | $30.66 | $30.33 | RVU24C |
| 2024-04-01 | $30.66 | $30.33 | RVU24B |
| 2024-03-09 | $30.66 | $30.33 | RVU24AR |
| 2024-01-01 | $30.16 | $29.83 | RVU24A |
| 2023-10-01 | $31.22 | $30.88 | RVU23D |
| 2023-07-01 | $31.18 | $30.84 | RVU23C |
| 2023-04-01 | $31.18 | $30.84 | RVU23B |
| 2023-01-01 | $31.18 | $30.84 | RVU23A |
| 2022-10-01 | $32.22 | $31.87 | RVU22D |
| 2022-07-01 | $32.22 | $31.87 | RVU22C |
| 2022-04-01 | $32.22 | $31.87 | RVU22B |
| 2022-01-01 | $32.22 | $31.87 | RVU22A |
| 2021-10-01 | $32.84 | $32.84 | RVU21D |
| 2021-07-01 | $32.84 | $32.84 | RVU21C |
| 2021-04-01 | $32.84 | $32.84 | RVU21B |
| 2021-01-01 | $32.84 | $32.84 | RVU21A |
| 2020-10-01 | Separate payment rules apply | Separate payment rules apply | RVU20D |
| 2020-07-01 | Separate payment rules apply | Separate payment rules apply | RVU20C |
| 2020-04-01 | Separate payment rules apply | Separate payment rules apply | RVU20B |
| 2020-01-01 | Separate payment rules apply | Separate payment rules apply | RVU20A |
| 2019-10-01 | Not in this release | Not in this release | RVU19D |
| 2019-07-01 | Not in this release | Not in this release | RVU19C |
| 2019-04-01 | Not in this release | Not in this release | RVU19B |
| 2019-01-01 | Not in this release | Not in this release | RVU19A |
| 2018-10-01 | Not in this release | Not in this release | RVU18D |
| 2018-07-01 | Not in this release | Not in this release | RVU18C |
| 2018-04-01 | Not in this release | Not in this release | RVU18B |
| 2018-01-01 | Not in this release | Not in this release | RVU18AR1 |
| 2017-10-01 | Not in this release | Not in this release | RVU17D |
| 2017-07-01 | Not in this release | Not in this release | RVU17C |
| 2017-04-01 | Not in this release | Not in this release | RVU17B |
| 2017-01-01 | Not in this release | Not in this release | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
98972 billing questions
When should 98972 be selected instead of 98971?
Use 98972 when cumulative online assessment and management time reaches 21 minutes or more during the service period. Code 98971 covers the shorter 11-to-20-minute level.
Can each portal message be billed separately?
No. Select the code using the cumulative qualifying time for the online service period, not the number of messages exchanged.
How is 98972 different from telephone code 98968?
98972 represents an online digital exchange. Code 98968 represents telephone assessment and management and uses a 21-to-30-minute time range.
What should the record show?
Document the established patient's concern, the online assessment and management performed, the relevant exchange, and the cumulative time supporting the 21-minute threshold.
Does 98972 describe a live video visit?
No. It describes assessment and management through an online digital exchange, not a synchronous video encounter.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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